Young Female Breast Cancer Survivors: Their Sexual Function and Interest in Sexual Enhancement Products and Services

Debra Herbenick, PhD, MPH; Michael Reece, PhD, MPH; Ariane Hollub, MEd; Sonya Satinsky, MPH; Brian Dodge, PhD, MS

Disclosures

Cancer Nurs. 2008;31(6):417-425. 

In This Article

Abstract and Introduction

Although American women are living longer after a breast cancer diagnosis, they may experience significant alterations in sexual function. However, little is known about the types of strategies that women are interested in using to address these sexual issues. This study used a reliable and valid instrument, the Sexual Function Questionnaire, to assess survivors' sexual function. Data were collected from 115 women who were younger than 50 years at diagnosis. Compared to normative controls, survivors scored significantly lower, indicating lower functioning, on most subscales of the Sexual Function Questionnaire and the overall measure, with the exception of the masturbation subscale on which they scored significantly higher. Most participants indicated moderate or strong interest in sexual enhancement products and comfort purchasing sexual enhancement products through various venues. Nurses and other health professionals might consider collaborations with entities of the adult retail industry to provide survivors with information about sexual enhancement products and their therapeutic potential.

Breast cancer is the most common nonskin cancer affecting women and the second leading cause of cancer deaths among women in the United States. It has been estimated that more than 2 million breast cancer survivors are currently living in the United States.[1] Although there have been significant advances in the early diagnosis and treatment of breast cancer and, as a result, more women are living longer after a breast cancer diagnosis, both the experience of having breast cancer and its treatments may challenge a woman's quality of life, particularly her intimate and family relationships.[2] Survivors frequently experience acute or chronic sexual function problems resulting from treatments such as mastectomy, lumpectomy, radiation, and chemotherapy. Although fewer than a quarter of breast cancer diagnoses occur in women younger than 50 years,[3] younger women may be particularly vulnerable to or distressed by treatment-related sexual function or fertility-related adverse effects of treatment.[4] The purpose of this study was to use a reliable and valid measure to examine the sexual function of women who were younger than 50 years at the time of their breast cancer diagnosis and to explore their interest in sexual enhancement products.

Relationships Between Breast Cancer and Sexual Health Concerns. Adverse effects of breast cancer treatment vary based on treatment type. Mastectomy (with or without reconstruction) and lumpectomy have been associated with altered body image, with the potential to affect sexuality.[5,6] Women who undergo mastectomy may also experience anxiety, depression, a decrease in sexual interest, or a decrease in perceived sexual attractiveness.[7] Although breast reconstruction may alleviate some concerns related to disfigurement, reconstruction is associated with a loss of breast sensation.[6,8]

Women who undergo radiation therapy may feel bothered by radiation tattoos, changes in breast sensation, fatigue, or arm mobility.[9,10] The latter may limit options-or necessitate different strategies-for intimate expression or sexual positioning. Radiation adverse effects are typically temporary; however, some women experience negative effects from treatment during the months or years after the completion of treatment.[9,10]

Tamoxifen therapy has been associated with pain, burning, or discomfort with intercourse as well as vaginal tightness.[11] More than other treatments for breast cancer, chemotherapy is consistently linked with a range of both acute and chronic adverse effects, many of which have the potential to negatively impact a woman's quality of life.[12] Among the adverse effects either directly or indirectly related to sexual function are altered body image (eg, due to loss of scalp and body hair or weight changes), fatigue or low energy, nausea, vomiting, vaginal irritation, dyspareunia, and the possible exacerbation of existing genital herpes lesions or human papillomavirus warts.[13] Furthermore, chemotherapy may cause women to experience ovarian failure, hormonal changes, menstrual cycle disruption, amenorrhea, decreased sexual interest or desire, vaginal dryness and atrophy, and decreased sexual arousal.[14] Younger women with breast cancer may experience a range of sexual concerns, as do older women, but may also be impacted by experiencing early menopause and treatment-related fertility problems and may face unique concerns related to parenting young children.[2,15,16,17,18,19]

The experience of a woman's sexual dysfunction after breast cancer treatment has been predicted by her having had chemotherapy and stopped menstruating after breast cancer diagnosis and having a history of hormone therapy that was discontinued upon diagnosis, vaginal dryness, increased time span since diagnosis, and a new partner.[20] Predictors associated with less sexual dysfunction included being African American, having better dyadic adjustment, remaining premenopausal after treatment, and having positive emotional well-being.

Although it is well documented that many female breast cancer survivors experience sexual adverse effects related to cancer treatments, there is very little research about strategies used by survivors to alleviate sexual concerns. Sexual function, body image, and relationship problems experienced by women due to breast cancer and cancer treatments may be addressed by individual and interpersonal counseling.[21,22] In addition, specific suggestions related to sexual positioning or the use of sexual enhancement products, as provided by nurses, sex therapists, or health educators, may help women alleviate some sexual problems.

Although research related to addressing these treatment-related sexual problems is minimal, some personal strategies used by women who have experienced sexual function problems have been documented. In one study, women who were treated for breast cancer and who were experiencing sexual dysfunction listed the strategies they used, if any, to alleviate their sexual problems.[23] Approximately 37% of the women in this study used a personal lubricant to facilitate more comfortable intercourse. However, approximately 16% of the women in the study who were experiencing vaginal dryness or dyspareunia were not using any products. Furthermore, most had never been counseled about their sexual concerns either by a physician or a nurse, suggesting the potential for opportunities to communicate information about alleviating discomfort or pain. In another study specifically examining sexuality after breast cancer treatment,[24] the frequency of sexual activity and vaginal lubrication decreased for at least one-third of the respondents. Genital pain was experienced at least half of the time by 26% of women, with the pain interfering with sexual pleasure most of the time for 18% of the respondents. Personal lubricants were used by only 32% of the women experiencing these symptoms.

Some researchers have suggested that water-based lubricants or vaginal moisturizers can improve dyspareunia without hormonal treatment.[25] It has also been recommended that women who have experienced vaginal stenosis or dyspareunia may be helped by the use of vaginal dilators, although the use of dilators has not been validated by empirical research. Others have suggested that patients may benefit from learning about sexual position adaptations that might presumably make sexual intimacy more comfortable, less painful, or simply possible, but these adaptations have neither been specified nor empirically tested.[26]

The Potential Role of the Adult Retail Industry in Sexual Health Promotion Among Breast Cancer Survivors. Although women may experience sexual function changes related to arousal, interest, desire, or orgasm, strategies to address these issues among female breast cancer survivors have rarely been studied. It is important to consider the varied ways in which adult women may seek out sexual health information, such as through nurses, support group leaders, friends, family members, magazines, the Internet, or adult retail venues. Adult bookstores often sell a range of products including condoms, lubricants, sexually explicit DVDs, lingerie, sex toys (eg, vibrators, dildos, masturbation sleeves), and novelty products. Previous research has indicated that these venues play a unique role in sexuality education, given the types of questions consumers ask adult retail employees and the commitment of the employees in many of these venues to support the sexual interests and needs of their customers.[27,28,29,30]

Another rapidly growing segment of the adult retail industry is that of in-home parties, several of which provide programming that is designed to address survivors' concerns about sexual function. These parties are gatherings that are coordinated by adult facilitators (usually women), situated in other women's homes, organized for groups of friends or coworkers, and similar in concept to Tupperware or Mary Kay parties; however, at in-home romance/sex toy parties, women can typically purchase massage products, personal lubricants, books about sexuality, novelty items, and sex toys for women, men, and couples. Usually, parties are structured so that the facilitator presents the products to the entire group of women during the "party" and then retreats into a private room of the house where one-by-one, women can enter and confidentially place their order.

Previous research has indicated that women, in addition to asking questions and seeking products similar to those in other adult retail venues, also ask in-home sex toy party facilitators questions about sexual function (eg, orgasm, arousal, desire, interest, pain, satisfaction) as well as questions about sexuality as related to specific physical health issues such as cancer, menopause, hysterectomy, and pregnancy.[27] In-home parties-which are sometimes organized through or in conjunction with survivors' support groups-may be particularly conducive for women's access to sexual enhancement products and information because the parties may present a comfortable women-only environment in which to discuss and learn about sexuality; privacy for ordering products; and an environment in which sexual curiosity, concerns, and interest are normalized.

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